In this blog, Policy Fellow Emily Hughes sets out how Shelford members are developing their thinking and approach with regard to improving health for their local populations.
Improving health outcomes
Policy thinking in recent years has seen the government, NHS, and wider society place greater emphasis on preventing illness and improving not only life expectancy, but the number of years we can expect to live in good health. While the importance of providing safe and effective healthcare to patients in need cannot be overstated, there is growing consensus that equally, we must focus our efforts on reducing avoidable illness and supporting people to stay well for as long as possible.
Our health outcomes are determined by a range of different influences, commonly referred to as the social determinants of health. Many of these determinants fall outside of our direct remit as healthcare providers, and we recognise in these instances our roles as partners and advocates for our local populations. At the same time, there are significant opportunities for acute healthcare providers to directly improve population health. The role of the provider in this context needs to be more clearly articulated, as well as more ambitious.
Our collective reach
Collectively, Shelford Group members employ over 175,000 people, and had over 19 million patient contacts in 2022-23 We are deeply rooted within major cities, some of which see the highest levels of deprivation in England, and we deliver a full range of community, secondary, and tertiary care. It is within this context that we wish to better articulate our role in improving health, and to challenge ourselves to go further.
To support this thinking, Shelford Strategy Directors have been working to break down the various ways in which members contribute to improving health for their local populations (see framework). This includes factors over which we have direct control – for example, being a good employer – and approaches that require partnership, working more effectively across our local systems.
Shelford framework for improving health
Developing this framework has allowed us to think more purposefully as a Group about our roles as acute providers, and to consider how we develop our approaches to go further. It has also prompted us to refresh one of our strategic priorities, expanding our work on anchor collaborations to include the broader elements of integration and population health.
The framework is made up of five areas:
- Influencing the social determinants of health as anchor institutions, through widening access to quality employment, procuring for social value, using capital and estates to support communities, working more closely with local partners, and adopting sustainable practices. Example: King’s College Hospital is partnered with Project SEARCH to provide 12-month internships and mentoring for young people with learning disabilities and/or autism.
- Integrated working with primary and community care partners in models that aim to break down traditional care barriers, and provide a more joined-up experience for patients. Example: in North West London, Imperial College Healthcare play a key role in Connecting Care for Children – an integrated care model whereby primary, secondary and tertiary healthcare professionals assemble in GP hubs. This model delivers early access to specialist knowledge for children and young people in familiar community surroundings, avoiding the often daunting experience of going to hospital, and supporting the ‘left shift’ from secondary to primary care.
- Supporting staff health and wellbeing by providing the 175,000 people we collectively employ with the appropriate settings, services and resources they need to be well. Example: Sheffield Teaching Hospitals are building on their existing staff wellbeing offer by delivering support services for key conditions, for example the Staff Physiotherapy Service, and support for Sheffield-based colleagues with Long Covid.
- Addressing health risk factors by making every contact count across the 19 million patient contacts we have every year. Hospitals have a powerful reach into their local communities; through A&E attendances, admissions, and outpatient appointments, there are opportunities every day to practically support people to improve their health.
Example: in Manchester, the CURE programme purposely sets out to medicalise the treatment of tobacco addiction, seeing it as a disease that requires medical treatment. The programme systematically identifies all people admitted to secondary care who smoke, and immediately offers them nicotine replacement therapy and specialist support for the duration of their admission and following discharge. - Providing preventative clinical interventions to prevent conditions from deteriorating, or in some instances, to prevent avoidable illness altogether. As tertiary care providers with strong links into life sciences, we are well placed to support secondary prevention and to advance research in areas such as genomics.
Example: the majority of Shelford members provide tier 3 obesity services, delivering weight management programmes and pharmacological treatments to support people to achieve a sustainable healthy weight.
Next steps
Over the next year, Shelford members – led by our Strategy Directors – will delve deeper into these individual areas. We have already explored in-depth our role as anchor institutions through a series of Q&A and case study blogs, as well as working with the Health Anchors Learning Network to showcase Shelford examples. We will next turn our attention to how members are making every contact count, with deep dives into member approaches and impact in addressing some of the leading risk factors for ill health.
This work will also consider the broader picture; in the context of growing demand for NHS services, as acute providers we must think differently about how we deliver care to best support the health and wellbeing of our populations, including through leveraging our strengths in research and education. However, to fundamentally change our health and care system from demand to prevention-driven will require a long-term and targeted approach – thought therefore needs to be given to the policy levers that could better incentivise and promote efforts to improve health.
As the Shelford Group develops its work on this agenda, we are keen to collaborate with interested partners. Please get in touch via our Policy Fellow: emily.hughes@shelfordgroup.org.